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ANTIBIOTIC POLICY
FOR
AIIMS BHOPAL
2017
1 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
I. Upper Respiratory Tract Infections
Condition Most likely organisms Drug Dose Duration
Acute bacterial rhinosinusitis
Streptococcus pneumoniae H. influenzae M. catarrhalis
Amoxycillin- Clavulanate 875/125 mg PO q 12 hours 7 days
In case of Penicillin allergy: Azithromycin
500 mg PO q 24 hours 3 days
Acute pharyngitis
Streptococcus pyogenes Viruses [Antibiotic administration only for patients who are most likely to have S. pyogenes infection: fever, tonsillar exudates, no cough, & tender anterior cervical lymphadenopathy]
Penicilin V OR
500 mg PO q 12 hours 10 days
Amoxycillin 500 mg PO q 8 hours
10 days
In case of Penicillin allergy: Azithromycin
500 mg PO OD 5 days
Acute epiglottitis [Airway management essential]
Children: H influenzae Streptococcus pyogenes Streptococcus pneumoniae S. aureus Adult: H influenzae Streptococcus pyogenes
Ceftriaxone OR
50 mg/kg IV 24 hourly
Cefotaxime OR
50 mg/kg IV 8 hourly
Levofloxacin AND
10 mg/kg IV 24 hourly
Clindamycin 7.5 mg/kg IV 6 hourly
Malignant otitis externa (usually diabetic or immunocompromised) Debridement usually required. Osteomyelitis to be ruled out.
Pseudomonas aeruginosa in > 90% cases
For early disease : Ciprofloxacin
750 mg PO q 12 hours
Up to 5 days after signs of inflammation resolve. 6 weeks in case of bone involvement.
For advanced disease : Ceftazidime OR
2 gm IV q 8 hours
Piperacillin-Tazobactum 4.5 gm IV 6 hourly
Acute Otitis Media Treat children <2 years. If >2 years, afebrile & no ear pain: consider analgesics & defer antibiotics
Streptococcus pneumoniae H. influenzae M. catarrhalis
Amoxycillin- Clavulanate 90/6.4 mg/kg/day PO q 12 hours
If age <2 years: 10 days If age >2 years : 5-7 days
If treated in past 1 mon: Cefuroxime- Axetil
250 mg PO q 12 hours
2 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
II. Lower Respiratory Tract Infections
Condition Most likely organisms Drug Dose Duration
Acute exacerbation of
chronic bronchitis
S. pneumoniae
H. influenzae
M. catarrhalis
Viruses
Chlamydophila
pneumoniae
OPD patient:
Amoxicillin OR
500-1000 mg thrice a day
5-7 days
Azithromycin 500 mg once a day 3 days
Indoor patient:
Amoxicillin-clavulanic acid OR
625 mg thrice a day
5-7 days
Cefuroxime OR 500 mg BD 5-7 days
Cefixime 200 mg BD 5-7 days
Bronchiectasis, acute
exacerbation
H. influenzae,
P. aeruginosa
Amoxicillin-clavulanic acid 625 mg thrice a day 5-7 days
Long term (in case of repeated exacerbation):
Azithromycin
500 mg thrice a week
1-2 months
Community-acquired
pneumonia (CAP) [non-
hospitalized patient]
No comorbidity
M. pneumoniae,
S. pneumoniae
Viruses
Azithromycin OR 500 mg OD 3 days
Amoxicillin 500-1000 mg thrice a day 5 days
Community-acquired
pneumonia (CAP)
[Hospitalized(Non ICU)
patient or with
comorbidities]
M. pneumoniae,
S. pneumoniae
Viruses
Amoxicillin-clavulanic acid OR 1.2 gm IV TDS 5-8 days
Cefotaxime OR 2-4 gm OR day IV 7-10 days
Ceftriaxone AND 2 gm IV OD 5-8 days
Azithromycin 500 mg IV OD 7-10 days
CAP in ICU- ( No risk
factor for pseudomonas)
S. pneumoniae,
H. influenzae,
M. catarrhalis,
Legionella spp.
Amoxicillin-clavulanic acid OR 1.2 gm IV TDS 5-8 days
Cefotaxime OR 2-4 gm OR day IV 7-10 days
Ceftriaxone AND 2 gm IV OD 5-8 days
Azithromycin 500 mg IV OD 7-10 days
3 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms
Drug Dose Duration
CAP in ICU (risk factor for multi-drug resistant bacteria like:
i. Antimicrobial therapy in preceding three months
ii. Present hospitalization of ≥5 days iii. High frequency of antibiotic resistance in
the community or in the specific hospital unit.
iv. Hospitalization for ≥48 hours in preceding three months
v. Home infusion therapy including antibiotics
vi. Home wound care. vii. Chronic dialysis within one month viii. Family member with MDR pathogen ix. Immunosuppressive drug and/or therapy
P. aeruginosa Acinetobacter Enterobacteriaceae
Piperacillin-Tazobactam CAN ADD
4.5 gm IV QID
10-14 days
Amikacin
1 gm IM/IV OD
10-14 days
4 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
MDR Pseudomonas Risk factor: Immunocompromised state, Chronic respiratory conditions like COPD, Asthma, Bronchiectasis; Enteral tube feeding, Cerebrovascular accident, Chronic neurological conditions.
P. aeruginosa
Piperacillin-Tazobactam CAN ADD 4.5 gm IV QID
10-14 days
Amikacin
1 gm IM/IV OD
10-14 days
Methicillin Resistant Staph Aureus
MRSA is rare in Indian ICU; So if MRSA is strongly suspected in late onset VAP/HAP in ICU having documented MRSA, only then Start MRSA empiric treatment.
MRSA Empiric Vancomycin OR Teicoplanin ( For 14 Days) Linezolid should be reserved due to potential Antitubercular effect and should be preferred only if pt is vancomycin intolerant or has concomitant renal failure or vancomycin resistant organism.
Aspiration pneumonia ± lung abscess
Anaerobes 34%, Gram-positive cocci 26%, Strep. milleri 16%, Klebsiella pneumoniae 25%, Nocardia 3%
Ceftriaxone AND
1 gm IV q 24 hours For aspiration pneumonia- 5 to 7 days Lung abscess-4 - 6 weeks
Metronidazole OR
500 mg IV q 8 hours
Clindamycin
1 gm IV q 12 hours
5 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
III. CNS Infections
Condition Situation/Severity Most likely organisms Drug Dose Duration
Meningitis
Immunocompetent S pneumoniae
N meningitidis
H influenzae
Ceftriaxone OR 2 gm IV q 12 hours 10-14 days
Cefotaxime 2 gm IV q 4-6 hours 10-14 days
Chloramphenicol (in case of Penicillin Allergy)
Immunocompromised S pneumoniae
N meningitidis
H influenza
GNR
Ceftriaxone AND
2 gm IV q 12 hours 10-14 days
Meropenem 2 gm IV q 8 hours 10-14 days
Post neurosurgery
Penetrating head trauma
Staphylococcus
epidermidis,
Staphylococcus aureus,
Propionibacterium acnes,
Pseudomonas aeruginosa,
Acinetobacter baumanii
Vancomycin AND
1.5gm IV Loading
1 gm IV q 12 hours
10-14 days
Meropenem
2g IV q 8 hours
10-14 days
Infected shunt S aureus
GNR (rare)
Vancomycin AND 1 gm IV q 12 hours 10-14 days
Meropenem 2 gm IV q 8 hours 10-14 days
Meningitis with basilar
skull fractures
Dexamethasone
0.15mg/kg IV q6h for 2-4
days (1st dose with or
before first antibiotic dose)
S pneumonia
H. Influenzae
Ceftriaxone
2 gm IV q 12 hours
14 days
6 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Situation/Severity Most likely organisms Drug Dose Duration
Organism specific
therapy
S pneumoniae Ceftriaxone 2 gm IV q 12 hours 10-14 days
N meningitidis Ceftriaxone 2 gm IV q 12 hours 7 days
H influenzae Ceftriaxone 2 gm IV q 12 hours 7 days
E coli Ceftriaxone 2 gm IV q 12 hours 21 days
S. aureus-MSSA Oxacillin 2 gm IV q 4 hours 10-14 days
S. aureus-MRSA Vancomycin 1gm IV q 12 hours 10-14 days
Enterococcus
Ampicillin AND 2 gm IV q 4 hours
Gentamicin 5 mg/kg IV q 24 hours
Candida species Amphotericin B 1 mg/kg IV q 24 hours
Cryptococcus Amphotericin B AND 1 mg/kg IV q 24 hours
Flucytocine 25 mg/kg PO q 6 hours
Encephalitis HSV/VZV Acyclovir 10 mg/kg IV q 8 hours 14-21 days
Brain abscess
Exclude TB,
Nocardia,
Aspergillus,
Mucor
Source unknown Streptococci,
Bacteroides,
Enterobacteriaceae,
S. aureus
Vancomycin AND 1 gm IV q 12 hours Duration
guided by
response
Ceftriaxone AND 2 gm IV q 12 hours
Metronidazole 500 mg IV q 6 hours
Source : Sinusitis
S pneumoniae
Anaerobes
Ceftriaxone AND 2 gm IV q 12 hours
Metronidazole 500 mg IV q 6 hours
7 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Situation/Severity Most likely organisms Drug Dose Duration
If abscess<2.5cm
& patient
neurologically
stable, await
response to
antibiotics,
Otherwise,
consider
aspiration/surgical
drainage and
modify antibiotics
as per sensitivity
of aspirated/
drained secretions.
Source : Chronic otitis S pneumonia
Anaerobes
Ceftriaxone AND 2 gm IV q 12 hours
Metronidazole 500 mg IV q 6 hours
Source : Post
neurosurgery
S aureus
GNR
Vancomycin AND 1 gm IV q 12 hours
Meropenem 2 gm IV q 8 hours
Source : Cyanotic
heart disease
Streptococci Ceftriaxone 2 gm IV q 12 hours
Note:
1. Antibiotic therapy must be started within 30 minutes of suspecting a CNS infection.
2. Please give Dexamethasome to all patients with suspected meningitis in the dose of 0.15 mg/kg IV q 6 hours for 2-4 days, ideally first dose
10-20 minutes before an antibiotic.
3. STOP Antibiotic treatment if LP culture obtained prior to antibiotic therapy is negative at 48 hours OR no PMNs on CSF cell count.
8 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IV. Skin and Soft Tissue Infections
Condition Situation/ Severity
Most likely organisms
Drug Dose Duration
Cellulitis
See note 1
below
Non-suppurative Streptococci Amoxicillin-clavulanic acid OR 625 mg PO q 8 hours 5-7 days
Amoxicillin-clavulanic acid OR 1.2 gm IV q 8 hours 5-7 days
Ceftriaxone OR 2 gm IV q 24 hours 5-7 days
Clindamycin 600-900 mg IV q 8 hours 5-7 days
Suppurative cellulitis or
cutaneous abscess
S aureus Doxycycline OR 100 mg PO q 12 hours 5-7 days
Clindamycin OR 300 mg PO q 8 hours 5-7 days
Clindamycin OR 600 mg IV q 8 hours 5-7 days
Vancomycin 1 gm IV q 12 hours 5-7 days
Cat/dog bite P multocida Amoxicillin-clavulanic acid 625 mg PO q 8 hours 5-7 days
Diabetic foot
See notes
2,3,4,5,6 as
below
Mild infection S aureus Amoxicillin-clavulanic acid OR 875 mg PO q 12 hours 7-10 days
Cephalexin OR 500 mg PO q 6 hours 7-10 days
Clindamycin 300 mg PO q 8 hours 7-10 days
Moderate infection S aureus
Streptococci
Psuedomonas
Enterobacteriacae
Ertapenem OR 1 gm IV q 24 hours 7-10 days
Ciprofloxacin AND 500 mg PO q 12 hours 7-10 days
Metronidazole OR 400 mg PO q 8 hours 7-10 days
Clindamycin 300 mg PO q 8 hours 7-10 days
Severe infection S aureus
Streptococci
Psuedomonas
Enterobacteriacae
Anaerobes
Piperacillin-Tazobactum OR 4.5 gm IV q 6 hours 7-10days
Ciprofloxacin OR 500 mg IV q 12 hours 7-10days
Aztreonam AND 1 gm IV q 8 hours 7-10days
Clindamycin 600 mg IV q 8 hours 7-10days
Piperacillin-Tazobactum AND 4.5 gm IV q 6 hours 7-10days
Vancomycin 1 gm q 12 hours 7-10days
9 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Situation/ Severity
Most likely organisms
Drug Dose Duration
Necrotizing
fasciitis
See note 7 as
below
S aureus
Clostridia
Anaerobes
Streptococci
Piperacillin-Tazobactum AND 4.5 gm IV q 6 hours Duration depends on
the progress Clindamycin 600-900 mg IV q 8 hours
OR
Imipenem OR 1 gm IV q 8 hours
Meropenem AND 1 gm IV q 8 hours
Clindamycin OR 600-900 mg IV q 8 hours
Linezolid 600 mg IV BD
Note:
1. Incision and drainage is preferred therapy in case of cutaneous abscess. Antibiotics are indicated if infection is severe, associated with extensive cellulitis,
septic phlebitis, diabetes, advanced age, or no response to I & D.
2. Uninfected diabetic foot has no purulence or inflamamtaion (erythema, pain, tenderness, warmth, induration).
3. Mild diabetic foot infection : Presence of purulence and one sign of inflammation.
4. Moderate diabetic foot infection : Mild inflammation and >2 cm of cellulitis, lymphangitic streaking, deep tissue abscess, gangrene, involvement of muscle,
tendon, joint, or bone.
5. Ulcer floor should be probed carefully. If bone can be touched with a metal probe then the patient should be treated for osteomyelitis with antibiotics in
addition to surgical debridement.
6. Duration of treatment depends on response. Usually 7-10 days after surgical debridement. Treatment is prolonged with osteomyelitis.
7. In necrotizing fasciitis, antibiotics are only an adjunct to surgical debridement.
10 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
V. Genitourinary Infections
Condition Most likely organisms Drug Dose Duration
Pelvic Inflammatory Disease
(PID), salpingitis, tubo-ovarian
abscess
Outpatient t/t: Patients with temp
<38°C, WBC <11,000 per mm3,
minimal evidence of peritonitis,
active bowel sounds & able to
tolerate oral nourishment
Initial inpatient
evaluation/therapy suggested for
patients with tubo-ovarian
abscess. Drainage of tubo-ovarian
abscess wherever .indicated.
Evaluate and treat sex partner.
N. gonorrhoeae, Chlamydia,
Bacteroides,
Enterobacteriaceae,
Streptococci
Gardenella vaginalis
S. aureus
.
Outpatient regimen option 1:
Doxycycline AND
100 mg PO BID
14 days
Ceftriaxone CAN ADD 250 mg IM OR IV Single dose
Metronidazole 400 mg PO BID 14 days
Outpatient regimen option 2:
Cefoxitin AND 2 gm IM Single dose
Probenecid AND 1 gm PO Single dose
Doxycycline AND 100 mg PO BID 14 days
Metronidazole 400 mg PO BID 14 days
Inpatient regimen:
Ceftriaxone AND
250 mg IM single
dose
For inpatient regimens,
continue treatment until
satisfactory response for
≥ 24-hr before
switching to outpatient
regimen.
Clindamycin CAN ADD
900 mg IV q 8 hours
Gentamicin
2 mg/kg loading dose
then switch to outpatient regimen
then 1.5 mg/kg q 8 hours
11 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Vaginitis
Candidiasis
Pruritus, thick cheesy
discharge, pH <4.5
Candida albicans 80–90%.
C. glabrata, C. tropicalis
may be increasing - they are
less susceptible to azoles
Oral azoles:
Fluconazole
150 mg PO
Single dose
Intravaginal
azoles:
Clotrimazole OR
200 mg vaginal tabs at bedtime
3 days
1% cream (5 gm) at bedtime 7-14 days
100 mg vaginal tab 7 days
500 mg vaginal tab Single dose
Miconazole 200 mg vaginal suppository at
bedtime
3 days
100 mg vaginal suppository
q 24 hours
7 days
2% cream (5 gm) at bedtime 7 days
Recurrent candidiasis
(4 or more episodes/ yr)
Fluconazole 150 mg PO q week 6 months
Clotrimazole Vaginal suppositories 500 mg
q week
6 months
Balanitis
Occurs in 1/4 of male sex
partners of women infected with
candida.
Candida 40%, Group B
Strep, gardnerella
Oral or topical
azoles as for
vaginitis
12 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Bacterial vaginosis
Malodorous vaginal
discharge, pH >4.5
Reported 50% ↑ in cure rate
if abstain from sex or use
condoms
Treatment of male sex
partner not indicated unless
balanitis present.
Etiology unclear:
Gardnerella vaginalis,
Mobiluncus, Mycoplasma
hominis,
Prevotella sp., Atopobium
vaginae etc.
Metronidazole
OR
Metro 400 mg PO BID 7 days
Metro vaginal gel 1
applicator intravaginally at
bedtime
5 days
Tinidazole OR
2 gm PO once daily 2 days
1 gm PO once daily 5 days
Clindamycin 300 mg PO bid 7 days
2% vaginal cream 5 gm at
bedtime
7 days
Vaginal Trichomoniasis
Copious foamy discharge,
pH >4.5
Treat male sexual partners:
Metronidazole 2 gm as single dose
Trichomonas vaginalis Metronidazole
OR
2 gm PO single dose
400 mg PO BID 7days
Tinidazole 2 gm PO single dose
For treatment failure:
Metronidazole
400 mg PO BID
7 days
2nd failure: Metronidazole
2 gm PO q 24 hours
3-5 days
Urethritis, cervicitis, proctitis
(uncomplicated)
N. gonorrhoeae
(50% of pts
with urethritis, cervicitis
have
concomitant C.
trachomatis).
Empirical t/t to cover both
pathogens
Ceftriaxone AND
250 mg IM Single dose
Azithromycin OR
1 gm PO Single dose
Doxycycline 100 mg PO q 12 hours 7 days
13 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Epididymo-orchitis
Age <35 years
Age >35 years or homosexual
men (insertive partners in anal
intercourse)
N. gonorrhoeae,
Chlamydia trachomatis
Ceftriaxone AND 250 mg IM Single dose
Azithromycin OR 1 gm PO Single dose
Doxycycline 100 mg PO bid 10 days
Enterobacteriaceae
(coliforms)
Levofloxacin OR 500-750 mg IV/PO once daily 10-14 days
Ciprofloxacin 500 mg PO OR 400 mg IV
twice daily
10-14 days
Acute Prostatitis
≤35 years of age
≥35 years of age
Note: Urine and prostatic massage
culture samples to be taken prior
to antibiotics.
De-escalate after the availability of
culture sensitivity reports.
N. gonorrhoeae,
C. trachomatis
Ceftriaxone AND 250 mg IM Single dose
Azithromycin OR 1 gm PO Single dose
Doxycycline 100 mg PO bid 10 days
Enterobacteriaceae
(coliforms)
Levofloxacin OR
500-750 mg IV/PO once daily 10-14 days
Ciprofloxacin OR
500 mg PO OR 400 mg IV
twice daily x
10-14 days
Sulfamethoxazole-
Trimethoprim
1 double strength (160/800
mg) tablet PO BID
10-14 days
Acute, uncomplicated cystitis/
urethritis in women
E. coli, other members of
Enterobacteriaceae,
Staphylococcus
saprophyticus, Enterococci
Nitrofurantoin OR 100 mg PO BD 7 days
14 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Young woman with typical
symptoms, pyuria present,
culture-negative
Chlamydia trachomatis Azithromycin OR
1 gm PO Single dose
Doxycycline 100 mg PO q 12 hours 7 days
Acute pyelonephritis
Note: Urine culture samples to be taken prior to initiation of antibiotic therapy and used to guide antibiotic regiment once the report is available. Monitor renal function
E. coli, other members of
Enterobacteriaceae,
Enterococci
Amikacin OR
1 gm OD IM/IV OR 14 days
Gentamicin
7 mg/kg/day OD IM/IV
14 days
UTI in hospitalized patient on
long-term urinary catheter
Enterobacteriaceae,
Pseudomonas aeruginosa,
Acinetobacter spp.,
Enterococci
Wait for C/S result.
If patient is in sepsis,
start
Colistin AND 2 million IU IV q 12 hours
Vancomycin 1 gm IV q 12 hours
until C/S results are
available
Chorioamnionitis Group B Streptococcus, Gram negative bacilli, chlamydiae, ureaplasma and anaerobes, usually Polymicrobial
Clindamycin OR Vancomycin Teicoplanin AND
Cefoperazone-Sulbactum
If patient is not in sepsis then IV Ampicillin
15 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Septic abortion Endomyometritis and Septic Pelvic Vein Phlebitis
Bacteroides, Prevotella bivius, Group B, Group A Streptococcus, Enterobactereaceae, C. trachomatis, Clostridium perfringens.
If patient has not taken
any prior antibiotic
(start antibiotic after
sending cultures)
Ampicillin AND 500 mg QID
Metronidazole 500 mg IV TDS
It patients has been partially treated with antibiotics, send blood cultures and start Piperacillin-Tazobactam OR Cefoperazone-sulbactum
till the sensitivity report
is available.
Obstetric Sepsis during pregnancy
Group A beta-haemolytic Streptococcus, E. coli, anaerobes.
It patient is in shock and blood culture reports are pending, then start Piperacillin-Tazobactam OR Cefoperazone-sulbactam
till the sensitivity report is available and modify as per the report.
16 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
If patient has only fever,
with no features of
severe sepsis start
Amoxicillin-clavulanate
OR
625 mg TDS PO/
1.2 gm TDS IV
Ceftriaxone AND 2 gm IV OD
Metronidazole
CAN ADD
500 mg IV TDS
Gentamicin 7 mg/kg/day OD
If admission needed.
MRSA cover may be
required if suspected or
colonized
(Vancomycin/
Teicoplanin)
Obstetric Sepsis following
pregnancy
Source of sepsis outside Genital
tract Mastitis UTI Pneumonia
Skin and soft tissue (IV site,
surgical site, drain site etc.)
S. pyogenes,
E. coli,
S. aureus
S. pneumoniae
Meticillin-resistant
S. aureus (MRSA),
C. septicum &
Morganella morganii.
Same as above
17 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
VI. Infective Endocarditis
Condition Most likely organisms Drug Dose Duration
Infective Endocarditis:
Native valve (awaiting
cultures) Indolent
Viridans Streptococci, other
Streptococci Enterococci
Penicillin G OR 20 MU IV divided doses
4 hours
4-6 weeks
Ampicillin AND
Gentamicin
2 gm IV 4 hours
1 mg/kg IM or IV 8 hours
4-6 weeks
Infective Endocarditis:
Navtive valve (awaiting
cultures) In Severe
Sepsis
S.aureus (MSSA or MRSA) Risk
for gram-negative bacilli
Vancomycin AND
25-30 mg/kg loading followed by
15-20 mg/kg IV 12 hourly
(maximum 1gm 12) hourly)
4-6 weeks
Meropenem 1 gm IV 8 hours 4-6 weeks
Endocarditis
(< 2 months);
Prosthetic Valve
Staph
Gram Negative Rods
Diptheroids
Vancomycin AND
25-30 mg/kg loading followed by
15-20 mg/kg IV 12 hourly
(maximum 1 gm 12) hourly)
Meropenem OR 1 gm IV 8 hours
Imipenem 500 mg IV q 6 hours
Endocarditis
(> 2 months);
Prosthetic Valve
CONS
Enterococcus
S.aureus
Vancomycin AND
25-30 mg/kg loading followed by
15-20 mg/kg IV 12 hourly
(maximum 1 gm 12) hourly)
Gentamicin 1 mg/kg body weight IV 8
hourly, modified according to
renal function
18 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
VII. Gastrointestinal & Intra-Abdominal Infections
Condition Most likely organisms Drug Dose Duration
Acute
Gastroenteritis
Food poisoning
Viral,
Entero-toxigenic &
Entero-pathogenic
E. Coli
S. aureus,
B. cereus,
C. botulinum
None None None
Cholera V. cholerae Doxycycline OR 300 mg Oral Single dose
Azithromycin OR 1 gm Oral 3 days
Ciprofloxacin 500 mg BD 3 days
Bacterial dysentery Shigella sp.,
Campylobacter,
Non-typhoidal
Salmonellosis
Ceftriaxone OR 2 gm IV OD 5 days
Cefixime OR 10-15 mg/kg/day 5 days
Azithromycin (drug of
choice for Campylobacter)
1 gm OD 3 days
Amoebic dysentery E. histolytica Metronidazole OR 400 mg Oral TDS 7-10 days
Tinidazole 2 gm Oral OD 3 days
Giardiasis Giardia lamblia Metronidazole OR 250-500 mg Oral TDS 7-10 days
Tinidazole 2 gm Oral Single dose
Hospital acquired diarrhea C. difficile Metronidazole OR 400 mg Oral TDS 10 days
Vancomycin 250 mg Oral QDS 10 days
Enteric fever (Outpatients) S. Typhi,
S. Paratyphi A
Cefixime OR 20 mg/kg/day 14 days
Azithromycin OR 500 mg BD 7 days
19 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Enteric fever
(Inpatients)
S. Thyphi,
S. Paratyphi A
Ceftriaxone (Ceftriaxone to
be changed to oral cefixime
when patient is afebrile to
finish total duration of 14
days) OR
2 gm IV BD
2 weeks
Azithromycin 500 mg BD 7 days
Biliary tract infections
(cholangitis, cholecystitis)
Enterobacteriaceae
(E.coli, Klebsiella sp.)
Amikacin OR 1 gm IM/IV OD 7-10 days
Piperacillin-Tazobactam 4.5 gm IV 8 hourly 7-10 days
Biliary tract infections
(cholangitis, cholecystitis) (For
serious patients and
documented ESBL producers)
Enterobacteriaceae
(E.coli, Klebsiella sp.)
Imipenem OR 500 mg IV 6 hourly 7-10 days
Meropenem 1 gm IV 8 hourly 7-10 days
Spontaneous Bacterial
Peritonitis
Enterobacteriaceae
(E.coli, Klebsiella sp.)
Amikacin OR 1 gm IM/IV OD Duration of treatment
is based on source
control and clinical
improvement
Piperacillin-Tazobactam 4.5 gm IV 8 hourly
Spontaneous Bacterial
Peritonitis (For serious patients
and documented ESBL
producers)
Enterobacteriaceae
(E.coli, Klebsiella sp.)
Imipenem OR 500 mg IV 6 hourly
Meropenem 1 gm IV 8 hourly
Secondary Peritonitis, Intra-
abdominal abscess/ GI
perforation
Enterobacteriaceae
(E.coli, Klebsiella sp.),
Bacteroides (colonic
perforation), Anaerobes
Amikacin OR 1 gm IM/IV OD Duration of treatment
is based on source
control and clinical
improvement
Piperacillin-Tazobactam
OR
4.5 gm IV 8 hourly
Imipenem OR 500 mg IV 6 hourly
Meropenem 1 gm IV 8 hourly
In very sick patients, if required, addition of cover for yeast (fluconazole IV 800 mg loading dose day 1, followed by 400 mg 2nd day onwards) & and for Enterococcus (vancomycin OR teicoplanin) may be contemplated
20 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Pancreatitis Mild- moderate
No antibiotics
Post necrotizing pancreatitis: infected pseudocyst; pancreatic abscess
Entrobacteriaceae, Enterococci, S. aureus, S. epidermidis, anaerobes, Candida sp.
Amikacin OR 1 gm IM/IV OD
Piperacillin-Tazobactam
OR
4.5 gm IV 8 hourly Duration of treatment is based on source control and clinical improvement Imipenem OR 500 mg IV 6 hourly
Meropenem 1 gm IV 8 hourly
In very sick patients, if required, addition of cover for yeast (fluconazole IV 800 mg loading dose day 1, followed by 400 mg 2nd day onwards) & and for Enterococcus (vancomycin /teicoplanin) may be contemplated
Diverticulitis- Mild (OPD treatment)
Gram negative rods, Anaerobes Amoxicillin-Clavulanate acid
625 mg TDS 7 days
Diverticulitis- Moderate Gram negative rods, Anaerobes Metronidazole OR 500 mg IV TDS Duration of treatment is based on source control and clinical improvement
Piperacillin-Tazobactam
AND
4.5 gm IV 8 hourly
Amikacin 1 gm IM/IV OD
Diverticulitis- Severe Gram negative rods, Anaerobes Imipenem OR 500 mg IV 6 hourly Duration of treatment is based on source control and clinical improvement
Meropenem 1 gm IV 8 hourly
Liver Abscess Polymicrobial Metronidazole OR 500 mg IV TDS / 800 mg Orally TDS
2 weeks. USG-guided drainage indicated in large abscesses, signs of imminent rupture and no response to medical treatment.
Piperacillin-Tazobactam
AND
4.5 gm IV 8 hourly
Amikacin 1 gm IM/IV OD
21 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
VIII. Sepsis: The choice of antibiotics depends on the source
1. Lungs : follow pneumonia guidelines
2. SSTI:
a) Extensive inflammation + Systemic Toxicity: GNB, S.aureus: BL+BLI (Piperacillin-Tazobactam - 4.5 gm iv Q8H) OR
Carbapenem (Meropenem 1 gm IV Q8H/ Imipenem 500 mg IV Q6H) + Vancomycin (1gm IV BD)
b) Necrotizing fasciitis: Streptococci, Anaerobes, GNB, Staph aureus: BL + BLI (Piperacillin-Tazobactam - 4.5 gm IV Q8H)
OR Carbapenem (Meropenem 1 gm IV Q8H/ Imipenem 500 mg IV Q6H) + Clindamycin (600 mg IV Q8H).
3. Secondary peritonitis: Enterobacteriacea, Bacteroides, Enterococci, Pseudo: BL / BLI (Piperacillin-Tazobactam - 4.5 gm IV
Q8H)
4. Primary peritonitis :S pneumoniae, GNB: Ceftriaxone/Cefotaxime (Ceftriaxone 1 gm IV BD)
5. Uncomplicated pyelonephritis: GNB: BL +BLI (Piperacillin-Tazobactam - 4.5 gm iv Q8H)
6. Pyelonephritis :GNB (E coli, Pseudomonas):Carbapenem (Meropenem 1 gm IV Q8H/ Imipenem 500 mg IV Q6H)
7. Severe Pyelonephritis, Perinephric abscess, Emphysematous pyelonephritis: GNB : Carbapenem (Meropenem 1 gm IV
Q8H/ Imipenem 500 mg IV Q6H)
8. Unknown origin: Carbapenem (Meropenem 1 gm IV Q8H/ Imipenem 500 mg IV Q6H) + Vancomycin/Teicoplanin
(Vancomycin 1 gm IV BD/ Teicoplanin 400 mg IV BD for one day, there after 400 mg IV OD for 2 days thereafter as per Cr Cl)
22 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. Pediatric Infections
IX. A. Pediatric Respiratory Tract Infections
Condition Most likely organisms Drug Dose Duration
Pharyngotonsillitis Most are caused due to Viruses
30% bacterial
-Group A hemolytic
streptococci
Group C Streptococcus
Arcanobacterium haemolyticum
Viral – no antibiotics needed
If bacterial: Inflamed enlarged
tonsils with pus points
Amoxicillin
-
50-75 mg/kg/day PO BD/TID
-
10 days
Penicillin 50-75 mg/kg/day PO BD/TID 10 days
Benzathine Penicillin
<27 kg: 6,00,000 units IM
>27 kg: 1.2 million units IM
Single dose
If penicillin allergic children:
Erythromycin
20-40 mg/kg/day PO BID/QID
10 days
Azithromycin 12 mg/kg/day 5 days
Diphtheria Corynebacterium diptheriae Erythromycin OR 20-40 mg/kg/day PO BID/QID 14 days
Azithromycin 12 mg/kg/day 5 days
Acute Otitis Media S. pneumoniae,
H. influenzae,
M. catarrhalis
Amoxicillin 40-50 mg/kg/day PO BD 7-10 days
Coamoxyclav 40-50 mg/kg/day BD 7-10 days
Cefuroxime 20-30 mg/kg/day BD 7-10 days
I.V. Ceftriaxone 75 mg/kg/day BD 7-10 days
Acute Sinusitis S. pneumoniae,
H. influenzae,
M. catarrhalis
Amoxicillin 40-50 mg/kg/day PO BD 7-10 days
Coamoxyclav 40-50 mg/kg/day BD 7-10 days
Cefuroxime 20-30 mg/kg/day BD 7-10 days
I.V. Ceftriaxone 75 mg/kg/day BD 3-5 days
23 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Ludwig’s Angina S. pyogenes
Staph. aureus
Penicilllin G AND
200000-250000 U/kg/day IV
q 6 hours
Clindamycin 40 mg/kg/day q 8 hours IV
Pertussis Bordetella pertussis Azithromycin 10 mg/kg/day PO OD 5 days
Clarithromycin 15 mg/kg/day PO BD 7 days
Erythromycin 40 mg/kg/day PO QID 14 days
Acute
laryngotracheobronchitis
Parainfluenza virus Antibiotics not needed - -
Acute Epiglottitis H. influenzae
S. pneumoniae
IV Ceftriaxone 50 mg/kg/day IV OD 7-10 days
Bronchiolitis Respiratory syncytial virus,
Metapneumovirus
Antibiotics not needed - -
Pneumonia
Community Acquired
Pneumonia
3 month- 4 yrs:
S.pneumoniae
S.aureus
S.pyogenes
≥ 5 yrs:
Chlamydophila pneumoniae,
Mycoplasma
24 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
Condition Most likely organisms Drug Dose Duration
Mild-moderate: Bronchopneumonia
(mostly viral)
lobar pneumonia
no antibiotic required
Amoxycillin
80-90 mg/kg/day QID
7-10 days
Moderate-severe Ampicillin 200 mg/kg/day QID 7-14 days
Ceftriaxone 50-75 mg/kg/day OD 10-14 days
Cefotaxim 150 mg/kg/day 10-14 days
MRSA Vancomycin 60 mg/kg/day 10-14 days
Mycoplasma Azithromycin 10 mg/kg/day OD 5 days
Nosocomial pneumonia Staph. aureus
P. aeruginosa
S. pneumoniae
H. influenzae
Meropenem 60 mg/kg/day TDS 10-14 days
Piperacillin-tazobactum 240-300 mg/kg/day TDS 10-14 days
Cefipime 150 mg/kg/day TDS 10-14 days
PLUS Gentamicin 6 - 7.5 mg/kg/day 10-14 days
MRSA Add Vancomycin 60 mg/kg/day 10-14 days
With Pleural
effusion/empyema
Staph aureus
Klebsiella
S. pneumoniae
Ceftraixone 50-75 mg/kg/day 2-3 week
Cefotaxime 150 mg/kg/day 2-3 week
Vancomycin 60 mg/kg/day 2-3 week
25 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. B. Pediatric CNS Infections
Condition Most likely organisms Drug Dose Duration
Meningitis H. Influenzae
N. meningitidis
S. pneumoniae
Cefotaxim 200-300 mg/kg/day QID 14-21 days
Ceftraixone 100 mg/kg/day BD 14-21 days
Vancomycin 60 mg/kg/day 14-21 days
Community Acquired GBS,
E.Coli,
L.monocytogenes,
S.pneumoniae
I.V. Cefotaxim
PLUS
150-20 0mg/kg/day TID 21 days for gram
negative ,
14-21 days for
GBS and other
gram positive
bacilli
Gentamicin 5-8 mg/kg/day OD
Hospital Acquired
(low probability of resistant
strains)
Staphylococcus,
CONS,
Gram negative bacilli,
I.V. Cefotaxim PLUS
150-200 mg/kg/day TID
I.V. Amikacin 15-20 mg/kg/day OD/BD
Hospital Acquired
(High Probability of resistant
strains)
Gram negative bacilli,
Pseudomonas
Staphylococcus
(MRSA)
I.V. Cefotaxim OR 150-200 mg/kg/day TID
I.V.Meropenem PLUS 120 mg/kg/day TID
I.V. Amikacin 15-20 mg/kg/day BD/OD
I.V. Ceftazidime 100-150 mg/kg/day BD/TID
I.V. Vancomycin 40-60 mg/kg/day TID/QID
I.V. clindamycin 20-30 mg/kg/day TID/QID
I.V. linezolid 30 mg/kg/day TID
26 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. C. Pediatric Gastrointestinal Infections
Condition Most likely organisms Drug Dose Duration
Dysentery Shigella Campylobacter
I.V. Ceftriaxone 100 mg/kg/day BD 7 days
Cefixime 20 mg/kg/day BD 7 days
Cholera Vibrio cholerae Azithromycin 20 mg/kg/day OD 5 days
Doxycycline 4 mg/kg/day BD 7-10 days
Enteric fever Samonella typhi, Salmonella paratyphi
Cefixime 20 mg/kg/day BD 14 days
Azithromycin 20 mg/kg/day OD 5 days
I.V. Ceftriaxone 100 mg/kg/day BD 14 days
I.V. Cefotaxime 100 mg/kg/day TDS 14 days
2nd line drugs:
Chloramphenicol 50-75 mg/kg/day BD 14 days
Amoxycillin 75-100 mg/kg/day BD/TID 14 days
Cotrimoxazole TMP: 8 mg/kg/day SMX: 40 mg/kg/day BD
14 days
Peritonitis E.coli, S.pneumoniae, S.viridans
I.V. Ampicillin 100 mg/kg/day 7-10 days
I.V. Cefotaxim 100 mg/kg/day 7-10 days
PLUS Gentamicin 5-6 mg/kg/day 7-10 days
Liver abscess
If pyogenic E.coli, Klebsiella pneumoniae, streptococcal sp., bacteroids sp.
I.V. Ampicillin 100 mg/kg/day 2-6 weeks
I.V. Cefotaxim PLUS 100 mg/kg/day 2-6 weeks
I.V. Gentamicin 5-6 mg/kg/day 2-6 weeks
I.V. Amikacin 15-20 mg/kg/day
If amoebic E. histolytica I.V. Metronidazole 30-50 mg/kg/day 10-14 days
I.V. Tinidazole PLUS 50 mg/kg/day 5 days
Paromomycin 30 mg/kg/day 7 days
Iodoquinol 30 mg/kg/day 7 days
27 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. D. Pediatric Urinary Tract Infections
Condition Most likely organisms Drug Dose Duration
Urinary Tract Infection E. coli, Klebsiella,
Proteus,
Staphylococcus saprophytius,
Enterococcus
If mild cystitis (3-5 days)
Parenteral drugs:
(if pyelonephritis)
Ceftriaxone
75-100 mg/kg/day BD
Switch to oral
following clinical
response
(7-10 days total)
Cefotaxim 100-150 mg/kg/day TDS
Amikacin 10-15 mg/kg/day OD
Gentamicin 5-6 mg/kg/day OD
Oral drugs:
Cefixime 8-10 mg/kg/day BD 7-10 days
Ciprofloxacin 10-20 mg/kg/day BD 7-10 days
Coamoxiclav 30-35 mg/kg/day BD 7-10 days
Ofloxacin 15-20 mg/kg/day BD 7-10 days
IX. E. Febrile Neutropenia in children
Condition Most likely organisms Drug Dose Duration
Febrile Neutropenia Staphylococcus aureus
Pseudomonas aeruginosa
Candida
Enterococcus
I.V. Ceftazidime 150 mg/kg/day TDS
AND I.V. Amikacin 15-20 mg/kg/day BD
I.V. Piperacillin Tazobactem 300 mg/kg/day TDS
I.V. Vancomycin 40 mg/kg/day QID
28 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. F. Pediatric Bone & Joint Infections
Condition Most likely organisms Drug Dose Duration
Osteomyelitis/Septic
Arthritis
Staphylococcus aureus,
Group B Streptococci,
Gram negative bacilli
pseudomonas
I.V. Coamoxyclav 100 mg/kg/day BD 4-6 weeks
I.V. Gentamicin 7.5 mg/kg/day OD/BD 4-6 weeks
2nd line drugs
I.V. Ceftriaxone 100 mg/kg/day BD 4-6 weeks
I.V. Cefotaxim 100 mg/kg/day TDS 4-6 weeks
I.V. Vancomycin 60 mg/kg/day TDS 4-6 weeks
IX. G. Tetanus in children
Condition Most likely organisms Drug Dose Duration
Tetanus C. tetani Crystalline Penicillin 1-2 lac unit/kg/day QID 10 days
I.V. Metronidazole 30 mg/kg/day TDS 10 days
29 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. H. Acute Infective Endocarditis
Condition Most likely organisms Drug Dose Duration
Acute Infective
Endocarditis
Streptococcus viridians,
Staph aureus are the leading
causative organism
Others are group D
Streptococcus,
Serratia marsecens,
Pseudomonas aeruginosa,
Crystalline Penicillin 2 lac units/kg/day
I.V. Ampicillin AND 200 mg/kg/day QID 4-6 weeks
Gentamicin OR 7.5/15 mg/kg/day BD 4-6 weeks
Amikacin 7.5/15 mg/kg/day BD 4-6 weeks
2nd line drugs
I.V. Ceftriaxone 100 mg/kg/day BD
I.V. Vancomycin 40-60 mg/kg/day TDS
I.V. Meropenem AND 60-120 mg/kg/day TDS
Amikacin 7.5/15 mg/kg/day BD
Gentamicin 7.5/15 mg/kg/day BD
Secondary prophylaxis Group A Streptococcus I.M. Benzathine Penicillin 1.2 million units Single dose
Oral Penicillin V 250 mg QID 10 days
Oral erythromycin 250 mg QID 10 days
I.M. Benzathine Penicillin
>30 kg: 1.2 million units
<30 kg: 0.6 million units
Every 3 weeks
Oral penicillin V 250 mg BD Every 3 weeks
Oral Erythromycin 250 mg BD Every 3 weeks
IX. I. Cellulitis
Condition Most likely organisms Drug Dose Duration
Cellulitis Staphylococcus aureus,
Streptococcus sp.
I.V. Cloxacillin 50-100 mg/kg/day QID 7-10 days
I.V. Cefazolin 100 mg/kg/day TDS 7-10 days
I.V. Clindamycin 30 mg/kg/day TDS 7-10 days
30 1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports. 2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
IX. J. Neonatal Sepsis
Condition Most likely organisms Drug Dose Duration
Community Acquired GBS,
Staph aureus, Gram negative
bacilli (E.coli, klebsiella)
I.V. Ampicillin 100 mg/kg/day 10-14 days
I.V. Gentamicin 5-8 mg/kg/day 10-14 days
Hospital Acquired
(low probability of resistant
strain)
Staphylococcus,
CONS
I.V. Ampicillin 100 mg/kg/day
I.V. Cloxacillin PLUS 50 mg/kg/day
I.V. Amikacin 15-20 mg/kg/day
Hospital Acquired
(High Probability of resistant
strain)
Staphylococcus,
Gram negative bacilli,
Pseudomonas
I.V. Cefotaxim 100 mg/kg/day
I.V.Meropenem PLUS
I.V. Amikacin 15-20 mg/kg/day